Pertussis vaccine--benefits and risks.
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Biomedical subjects
Publications and source records attributed to G T Stewart.
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HEALTH education conventionally takes one of two forms, a mass campaign to the whole population using the media, or an approach to members of chosen at-risk groups, through individual or small group sessions. The following study explores the efficacy of one-to-one education of the whole adult population, at risk or not, by visiting a random sample of them in their homes and giving them information on one of four relevant topics, adapting the style and content to the individual's needs and interests. The survey therefore tests the technique of a flexible, person-orientated approach to health education.
A RANDOM sample of adults in Glasgow was surveyed by trained interviewers to determine public knowledge on four topics chosen specifically for each of four age groups. The topics were: Welfare rights and services; Coronary Heart Disease (CHD) and individual action that can reduce risk; The dangers of smoking in pregnancy; and fluoride and its functions and the connections between good health and habitual behaviour.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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An exponential model based on the infectious disease model of Kermack and McKendrick has been simplified to illustrate how the use of heroin spreads in epidemic fashion. A numerical simulation is arranged to show how the dynamics of spread are influenced by the original number of users, rates of conversion, and time of removal from the drug scene of those secondarily affected. The spread is significantly increased by small increases of those originally affected, in which case reduction of spread requires a large increase in rate of removal. The model indicates a strategy for intervention which is discussed in relation to policies for control of drug abuse.
Herd infections, especially in children, are strongly influenced epidemiologically by social and demographic factors which have contributed favorably to a general decline in incidence and mortality during the past 50 years or more. Intervention procedures such as immunization cannot be evaluated or planned realistically except against these background factors. Assessed in this way, immunization against diphtheria and poliomyelitis was unequivocally effective in reducing incidence and morbidity of these diseases. By comparison, pertussis vaccine has a very limited protective effect, the value of which, as morbidity decreases, may be offset by the intrinsic toxicity of the vaccine and by the possibility of infrequent but severe brain damage in some children.
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Calculations based on the mortality of whooping-cough before 1957 predict accurately the subsequent decline and the present low mortality. Notifications of incidence, though variable and incomplete, follow the same pattern of steady decline in the United Kingdom and are unaffected either by small-scale vaccination beginning about 1948 or by nationwide vaccination beginning in 1957. When valid comparisons can be made, attack-rates may be lower and complications fewer in vaccinated children, but allowance has to be made for overcrowding and socio-economic differences which may be more important as determinants of attack-rates. No protection by vaccination is demonstrable in infants. Adverse reactions and neurotoxicity following vaccinations were studied in 160 cases. In 79, the relationship to pertussis vaccine was strong. In 14 of these cases, reaction was transient but characteristic of a syndrome of shock and cerebral disturbance, which, in the other 65 cases, was followed by convulsions, hyperkinesis, and severe mental defect. It seems likely that most adverse reactions are unreported and that many are overlooked. Precise information about the efficacy and safety of this vaccine is lacking, because existing provisions, national and international, for epidemiological surveillance and evaluation are inadequate. The claim by official bodies that the risks of whooping-cough exceed those of vaccination is questionable, at least in the U.K.
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